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BOARD MEMBERS QF SO(/r Southold Town Hall Leslie Kanes Weisman,Chairperson �� y� 53095 Main Road•P.O.Box 1179 Southold,NY 11971-0959 Eric Dantest [ Office Location: Gerard P.Goehringer G Q Town Annex/First Floor,Capital One Bank George Horning �� ® y� 54375 Main Road(at Youngs Avenue) Kenneth Schneider IyC0UNT1 Southold,NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel.(631) 765-1809• Fax(631)765-9064 APR 13 2016 American Heart Association 125 East Bethpage Road, Suite 100 Plainview,NY 11803 Attn: Nora Donnelly Re: Event Permit#WP318-Healing Heart 5K Dear Ms. Donnelly: Enclosed is the Special Permit for the event planned for May 15,2016. A duplicate of this permit must be continuously posted during the event. This permit,is granted as applied for, based on information supplied in the application. There are several conditions written into the permit as well as the following ADDITIONAL CONDITIONS: 1. NO PARKING PERMITTED ON DEVELOPMENT RIGHTS SOLD LAND. 2. ALL PARKING WILL BE AT THE CUTCHOGUE ELEMENTARY SCHOOL. 3. ALL CROSSING OF PEDESTRIANS WILL BE PERFORMED BY SOUTHOLD POLICE DEPARTMENT. Please be aware that under the State Fire Code,the number of persons occupying the building and/or tent area is limited. The use of a tent will require an application and approvals at least three days before the event, from the Building Department. A Town Building Inspector must inspect the tent, before occupancy,they can be reached at 765-1802 between the hours of 8 a.m. and 4 p.m. This permit does not authorize parking on Suffolk County Right of Way located in front of the property or any lands owned by County of Suffolk, Town of Southold or Peconic Land Trust. All parking and traffic controls are the responsibilities of the event operators, and their ---------agents:Note-that par-king-on-any-County-or--State-Roads-are-not-authorized-under-this-permit:---- - - --- - ---- Any violations of this permit can be cause for revocation. The Town also reserves the right to r revoke any permit or deny future permits if the event(s) generates unforeseen impacts to the health, safety or welfare of residents and guests of the Town. inc re , Leslie Kanes Weisman Chairperson Encls. Copies of Event Permit to: Town Building Department Town Police Department Fire Inspector, Building Department 62/1312615 2":35 151645`°"50 �'. HMERICAIJ HEART ^qcU)C PAGE 62/63 land preserved through Nae sale of dcvelopment rights to the county of,Suffolk with a permit issued 1,y the Sar.folk County Farinlartd Contnihice. .f;food is to be served, it rnust be catered and prepared nf,)=site by food vendors who hold a Jperinit to operate issued by the Sis OR C'owq Bureau v,f.Puhlic Ffealth.,Food Protection Unit. -APPLICATION FOR A PERMIT TO HOLD A PCEIVED P 313SPECIAL)CV>EN T Please provide ALL of the information reauested below.Incomplete alpplicationsL,D 40T ga16 Loje-wed. Special Event Permit ti._ /3/_� ZONING BOARD OF APPEALS Date of SubmissioA�,CQ Name of Event American Heart Association Healing Heart 5K SCTM #i's 1000-Section Block Datcs of Each Event: May 15;2016 T' Nature of hent:l-lealing,1 Zeart 5K (Pleme attach a detailed description to this-np Kzfl;iogp) Time Period(Hours)of E'ven't: Froin 5:00 am to 2:00 pin Maximum Nurnber of Persons Attending At One Time; 600 Number of cars expected 250 Is a Tent or other tcmporafy structure being used? [X]Yes [ ]No If yes provide sizes) -- (1) 20x40, (1) 40x4,0, (2) 20x20 Will food be served?[K1 Yes j 1 No ifpes provide number and narne(s)of food vcndor(s) y�e ill lie serving_pxe }z c�caged_to do y Suffolk County pern7i0i (s)� Will other vendor-,be on the premises during the event?i'X 1 Yes f ]No 11"yes how many? Describe type ofvendor(s) sponsors,\ivili be set a?at_tabics Lo give away information Contact Person and Contact"fel:'#Nays Donnell}� 516-962.0799 _.__ Event Location: Street-Hamlet Address:Pugliese Vineyards- 34515 Main Rd.Cutchogue,NY Mailing Address to Send EVent Permit to: American Heart Association 125 last Bethpage Rd.-,Suite 100-Plainview,NY 11303 Have any of the dcvelopmdnt-rights been sold to the Town of Southold [ � Yes [ o and/or Suffolk County? ] Yes o\ If yes to eitlter of lac,th also indicate on t ached plan the boundaries of the t'es recd area upon which the event will take place. YO1LT MUST ATTACH A FARRINGI VENT PLAN TO THIS Aai'I'LICATION(see next pa,9 , IF THE Exrr,,CTEI2A T,E DANCU IS 300 OR VQRE FEO�LE-YOIJ 1liIXJ �'AL50 A.`l"I'ACII$ A TRAIT J'IC CQNTR0L PLr9AN(see nP-,t nage 2 A Parkin vent Plan may be a spnLey.site tolan and/or aerial view for MAIN* a Earth of the subject pr nerty.DMICATE ON In rLAN ALL of the foWwinng information ' A parking/event plan showing: (1) The size of the property and its location in relation to abutting streets or highway's. (2) The size and location of any existing building(s)or structures)that will be in operation during the course of the event and any proposed building,stntctum,or signs to be erected temporarily for the event. (3) The location of the stage or tents,if any. (4) The designated areas of use for spectators,exhibitors,vendors,employees and organizers, (5) Location of all eiLits. (6) The location of all fire extinguishers and other fire safety equipment. (1) The location of all temporary utilities to be installed for the event,if any. (8) The layout of any parking area for automobiles and other vehicles and the means of ingress and egress for such parking areas. The parking spaces must allow for 300 sq.ft. per car, (9) A traffic control plan for vehicles entering and leaving the site for the proposed event. (10) ` Plau for the use of live outdoor music,loudspeakers and other sounds which will be used, if any,and the type and location of speakers and other audio equipment. (11) A description of emergoncy access and facilities related to the event. (12) provisions to dispose of any garbage,trash,rubbish or other refuse_ (13) Location and description of any additional lighting to be utilized in conjunction with the event. (14) Location of sanitary facilities on site_ Traffic Control Plan Events for three hundred(300)or more people also require submission and approval of a traffic'coMoi plan, acceptable to the Town of Southold,AND,agualified traffic controller must be Please attached a written description and/or notate on the parking event plan the following: 1.who will be conducting traffic,2.where they wiU be stationed on site,3.how they�will direct the entrance,eiroulation,parking,and exiting of Cars on site,and 4.contact information for use by Southold Town Police. I am-the Owner of the Property where that event is to be held and do agree to comply*with the laws, rules, regulations, conditions, and requirements of the Code of the Town of Southohii, including but not limited to the eondldons fisted below, as well as all other applicable agency rales and regulations pertaining to Nre aedvfties under this event -*f .. *rint'nLamLeof . ignature of 0 er Kathy Munsch Print name of Authorized Person filling out Signa of Autb6rized Person filling out application application PERMISSION IS HEREBY GRANTXD.SY7=CT TO THIS FOLLOWING CONDITIONS: 1. By acceptance of this permit, applicant agrees to adequately supervise and direct aU parldng to be on the premises or at another site,and to provide parbug assistants and any additional traffic controls necessary for this event.rgkft gWjiy pEauNtedPark' on ANY Town,Coen gL&ft&@ds or Rights of Way. 2.. Traffic control at events for three hundred(300)or more people shall be provided by a qualified traffic controller in accordance with the attached,approved traffic control plan. 3. One°ongnvmises"sign not larger than six(6)square feet in size may be displayed not longer than thirty(30) days before this event, and rcnVvQI9@9ediataly after the event Directional parking signs shall be adequately displayed. MAR 1' 2016 Pj l� 3 ZONING BOARD OF APPEALS ti0/89 29vd 3S=ond 899968LT89T 98:£T -9T9Z/9Z/T0 4. Applicant indemnifies and holds harmless the Town of Southold from all claims, damages, expenses, suits and losses including but not limited to attorney's fees arising from activities under this permit. 5. Tent proposals must receive permit approval from the Southold Town Building Inspector before placement on the property and must meet all fire and safety codes. 6. This permit is valid only for the time, date, place and use specified above, and for the designated event. Each additional day will require a separate permit application, fee, and related documents for review, etc. at least 60 business days prior to the scheduled event. 7. Adequate temporary sanitary facilities must be provided by applicant for this event and applicant agrees to remove the temporary facilities from the premises within 48 hours after the day of the event. 8. On-site food preparation is NOT permitted, although food may be catered subject to all Suffolk County Department of Health regulations. 9. NO activities associated with this event, including but not limited to parking, ingress/egress/access, tent(s) temporary structure, or temporary sanitary facilities, shall be conducted on Town of Southold Purchase of Development Rights land. 10. NO activities associated with this event including but not limited to parking, ingress/egress/access, tent(s) or temporary structure(s), or temporary sanitary facilities, shall be conducted on Suffolk County Purchase of Development Rights land without a permit issued by the Suffolk County Farmland Committee. 11. Issuance of this permit does not authorize in any manner the occupancy of any building exceeding the legal limitations under the fire code or other codes which would prohibit such increased occupancy. 12. Access shall be provided for emergency vehicles,to all public assembly areas, all buildings, all work areas and any additional area where emergencies may occur. Two emergency-fire exits and exit paths from the building(s) on the property,to a public way or remote safe area,shall remain open and unobstructed at all times. 13. Owner assures that all fire, safety,building, and other laws will be complied with. 14. Music,when outdoors, is required to stop at the time specified in the permit. Placement of the speakers must be to a location that affords the greatest protection from noise intrusion upon adjacent properties. 15. ADDITIONAL CONDITIONS: a. NO PARKING PERMITTED ON DEVELOPMENT RIGHTS SOLD LAND. b. ALL PARKING WILL BE AT CUTCHOGUE ELEMENTARY SCHOOL. c. ALL CROSSING OF PEDESTRIANS WILL BE PERFORMED BY SOUTHOLD POLICE DEPARTMENT. ANY VIOLATIONS IN CONNECTION WIYTCONDITIONS ISTED HEREIN WILL TERMINATE THIS PERMIT. Date Issued: SPR 13 2096 !� ( APPROVED, ZBA Chairperson p J d ZBA Town of Southold 1 Office Location: 6tECEIVED 54375 Main Road(Capitol One 1"floor) PO Box 11971-0959 LIAR 2016 Southold,NY 11971-0959 Tel: (631)765-1809(press 5012 at voice recording) Updated August 2013 Fax(631)765-9064 ' ZONING BOARD OF APPEALS 4 02/13/2616 23:21 151645R4ih0 AMERICAN HEART ASSOC PAGE 02103 02/2912016 21:3.6 631,�_ ?99 CUTCHOGUE EAST PAGE 02/03 19./28/2010 15;? �51G�1a�91�,q AWPICAN WART ASSOC PAGE 05/06 IJ C,1<lltISR tJ $15L1'O1! 4 U A.SL' I?1aa9R°31t61ait for;ar to; `, Y�len9a nttbnnit�rm ttl; Jr,/Sh High School Pri1l'APa1 Nlathftlak Ir/Sr,fligil School Blesecntar31 Sel3b,h1 Nticipal Is,25 Main Road CrttChWa sm Elcmantary School ivt001114k,NY 1 f9k, 34.4110 Main head (631)298.8440 Cul--hopo,"11435 (631)298.0544 Pax. (631)734-6049 (631)794.49,99 Fax rtRQUEST FOR US)R OTU:SCHOOL FACILITIES ftrt A Dole 8t1$rktitx ci 17—„ 1. 1`Iilll3eaCOr .lnizatlla�Regttacting noility .t1.MeMitu Renr;tAssoclatlofl Individtrof RatanAablc for oral„ettir5rl Nota Ua�raclz�r 3. Addlramjj 5-.East D4thW2d, City/stata/741�'PIt>.1arvlew 11803 4, F40ility Requaste- Building Pa k'ti' .L0t Plj 9C °varilow parldyag eQ;,3X ffit p1jele9e VineyArd$ Rom or Roms'”'Cettchogtle,tlnst Elametatary (Suter 5. Tuna ei:llcar - , , Data UISMOM 1s the tlgte a Host-sehonl d�ky7 lm. n rqo 1 plattMR�Z� Oatn.-2cUQ t If area yt u Mont complete Part E i1 1 0. Is the activity gpeu to the 11pbtic?lz M, 11 rqIf the nativiiy has 50 or tnnke pat tidll?tlpt9 or the notivity it of a PhYgigai naMro(i.e.b41 kotiltt)1,voAtling,mte,)you must cordplota Paul R 01 &2, 7• Ie'Ssitrrlssian►tete$cltar8gd? YES tf Veq please Provide detgi led vxplanatiol)of tree rif praceedg, For n1grt M nand'Wkero ozdy 81 Dna$the activity 1`1+91111'4 bringing other atlttipntent 10Vic facility or motring=lsting ogq(1?trrm or furniture on the Facility? rj v rs •IN NO fl'yee,plraSe fill vitt Pnrt R#1,2,and 5, 91 To onyone as5ooiattaii wltlt th,ta activity recoivinA g etipml? U VMS 0 NO Part Is tf yr>p nava Uccn MW916d to fill 0111 PAR 13,A If or some of the itetmn mAy Apply to you, I, If YOU 13RVD t'egPested to Sam tl)e fmility. Har a non-school day,m`P3S,40 per hr yr Rise of building fan fat a avotodian to opAn ql)0 Monitor the handing duff i be ehurged. Tiltet-o io q two(2)11'0111'minimum fq'Ns nhttrr,tf them is it need{br m4ft dean one cttstadiatt the fee vAll be an additional$35.00 per(tour for arUclt crtgtodinn,see Me i�c J(t 1911 t)�tau drat is atiachad for sperlfic fees, 21, For the pt9f=ionof your argtini9 cion and the 171/11101 fi m'Unci against any 1191)041 4,logs or damage, hi tffa co»mp of pout orgarrleadon 1laitip Cha facilitica,th6 ctt84nization W111,at its own erose,parry insorattan wilioh tnny,bc rPtll1ll'a41 10 provide the necoognty protect on agalul,,Such foga or damage.(See 5 Te4urance 7tequlrn ir,.tttr of the 1714..41]�aeiliein o is�thttt is attaolietl), W P 3�d RECEIVED MAR 1 2016 ZONING BOARD OF APPEALS 02/1312016 2'3:21 151645E+a'-G4_1 AMERI13AN HEART A-�snC PAGE 03/03 02/29/2015 21:16 63;7-,99 CUTCHOGUE EAST PAGE 03/03 11128/2025 7,9:22 IrsIS4.5eS1G0 'A RTCAN H5A C ASSOC PAS gi1"Slp1; All feeq multi,be k1kixd and proof or'ra iraanre must be projgdetl&e dgys pTjgr>tjD dje 4Cdvjjy. plea e MAke all Lkleckr paryj�te 1,0 tl)e: 3. Please provida the Distridt with a detailed tixpintttqftn of yor pyrtaogm,your stood for assistance from the distT14t panletrnrsl,10itsmaik 0%02.If nee64srary,and a lint of ahaperonos. �Of additional spam its nodded P10fise attach another sheet) 4. Chaperones: (If nt ccssitry,AUtltriit ndditlonal names) Tito undersigned i5 over 21•ycnra of age and hat mgd thin fttrtn nett annehad rnoutatians and uggr4u M cotnply VA61 91141A. Ramha:rgrees to be rosponslbk to the Pjrtrlot for the tr®e and we of the fbellida®. Ndaha,or bohAff of their organization ctfi s hereby covenaht W aortae to derentl,Indemnify anti hoW harmless did 0105 from nW apiw noy and a(l'llability,Io%dar"p,claims ar aetlnno(inaluding costs and dttarnoy,d i'GCA)I&bodily Injury'aq hsr pmpady damiga,to the axtrnt pamlflplbio by law,nrising a*of or in aonnsctinn with the dotudl yr prepared nes orpjaxca property,fdollitirs and/or itrvious by their organtutian. �Igntitla+ . "PY L' 'Title. ;ygt7f—'Gt►atxlir7Atot Cpbrron"king w 1fedo it) l�l>ara roved (139f1dingFtti�elpal) PP Plata• �,�,�,,,�,I` "1Fe>t I'rarfkii9�Vdraltdn�:citsgc nytao Iam srttd ztta ru t:,aagpatl feet `dor,PtOP , arttd OW061A fee 'Fox t�OO-lP�rnjt�P wela Asty:charge no tans "For Nan.I'>I'o1lt"wulcoodlltolidayt chalt'gc You Comments; Y4t1 linyo Ntr right,if disstpltrdg+ad,tp appc:ll to the Boud of Bducadoq wlaase decision is pinnl. RECEIVED MAR R 2016 .ZONING BOARD OF APPEAL 02113/2016 22:35 151645x^!:" '0 AMERICAN HEART a=r--,nC PAGE 03103 Alt 3. °rt",- _ � .� (n• �'., v"�"`v�"s.�'icic i�l'•,t*,,'� s1=- _ 'Yin, �- �'����.;f�_-�•T_ �'�4'r`�.�.+5_gro�>ti 'li�u� ,y I � `:fl§;� r^, •�y':�,,�,.`� s,==y?�'s_�a`:>s*' - ��'(,I ry J.� • �� �Y - R��o�l M I`,{'�'s _� - '•�" �5+�a t';�- "'�: e.=r+�_`'s,�- _ ..4 ja�'�`* �'eb,3`�j'=z`r V-_ -. ,f`45�-� �f'�� :'•u`� �S> 0,13 -s =^�La'..P"�,,;�x�=' - f�"if �3`e gr.,�'—��.o�-�8�t";"�$'+• } ��i�i��, �..� ��ID"��. �.#��' �' �?�`•`- _ =-ter":s ". ->u ,�:,,. ysc' .�` .x;:,€�r�_ .-,'- •`�`a"�r it �"�+ +$�l"" T _ �r.� � - sly ^.9� ' -�:--� � Ct �d'`a;�'n='R,^~`� ,�,-,+ '� ' „ae,; F •;j� „ �'� �. 1{"��§i�eNt Bt `1�',N!"i, _ ��."'F .>., ��' �F`' �,",�^ y'G��'�;>ti�- �� _ .,�,�•�_ _�i-�"`'' , y "94~ p ��'r�'Ay.� mss, ��, ��^'_ =�-�s��-���. `� ����,�'-"�-'s a=_� ' - +r `•.-fid -_ _ ��. ,k +�� '��',F; �, *'- s,�^%i��� h �`a,�.. _-i `�-?sT = _- ,111 f�RS'y�"�f -- �'P �A.•3^�.�-�' .,yr•� _ "3 5iv, roved for extra ears ati , ;. Parkin has kieer�app Cutchogue East erataxy -r .' -7g- _ F _ „^. � ,YtSn=+,=,-vlp`" _ h„ _ '4r� � ,` - -, - .,Je 1'.� �'��Y� ��T`Y4•�cr^ +z�<<-S»�i•~���'`2'F.'-n: +��afA c ati. •T^ �r �O`�,s �<b-�_ �ari�.`�. � ti�. �ECBNBO MAR 1 2016 ZONING BOARD OF APPEALS PARKING z ZQx-2Q-', -20- 20x matit ob 2- .-Mattituck, Z KI one FOOD! V' S tr�i .Fye 4W, 001. 'Vendor Tent 6-, �Z Al _Z1 5k RECEIVED MAR 2016 PARKING ZONING BOARD OF APPEALS RESTROOMS_--Behind Tasting Room DATE'MM ACQI?" CERTIFICATE OF LIABILITY INSURANCE 1212212015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Marsh USA,Inc PHONE 4400 Comerica Bank Tower ac No ain Street E-MAI 1717 L M ADDRESS: Dallas,TX 75201-7357 Alin.Dallas.Certs@marsh corn Fax.212-948-0519 INSURERS AFFORDING COVERAGE NAIC# n/a INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:American Guarantee and Liability Insurance Company 26247 American Heart Association Founders Affiliate INSURER C:Axis Insurance Company 37273 125 East Bethpage Road,Suite 100 INSURER D: Plainview,NY 11803 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: HOU-002720197-01 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE iriqn WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY GLO 8376157-20 07/01/2015 07/01/2016 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE M OCCUR PREMISES Ea occurrence $ 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO F LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT $ OTHER A AUTOMOBILE LIABILITY BAP-8376159-20 07/01/2015 07/0112016 COMBINED SINGLE LIMIT g 2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B X UMBRELLA LIAB X OCCUR AUC 9300308-14 07101/2015 07/01/2016 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION$ _ $ q' WORKERS COMPENSATION WC 8376109-20 07/01/2015 07/01/2016 X STATUTE EH R AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE N NIA E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ C' Property MCB787839-15 07/01/2015 07/01/2016 Limit: 145,131,225 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RECEIVED p Re-7th Annual Healing Heart 5K,511512016,Cutchogue,NY i 3/ Q Town of Southold islare included as Additional Insured,except on Worker's Compensation and Property,as Owner of premises leased or gratuitously offered for the American Heart Association,Inc.off premises events,but only with respect to operations of the American Heart Association,Inc MAR 1 ?016 u J 16 ZONING BOARD OF APPEALS CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn.Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjeeoc�.�ao►„u @ 1988-2014 ACORD CORPORATION, All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACQRD 212 345-5000 12/15/2015 3 : 07: 19 PM PAGE 2/003 Fax Server DATE(MINDDrYYYY) ACCM.I� CERTIFICATE OF LIABILITY INSURANCE 12/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh USA,Inc NAME! PHONE 4400 Comerica Bank Tower ArC,tv"�). A C,No): 1717 Main Street _MAIL —-- Dallas,TX 75201-7357 ADDRESS, Alin Dallas Certsi!t marsh com Fax 212-948-0519 ___ INSURER( AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company 16535 INSURED INSURER B:American Guarantee and Liability Insurance Company 26247 American Heart Association Founders Affiliate INSURER C:Axis Insurance Company 37273 125 East Bethpage Road,Suite 100 INSURER D: Plainview,NY 11803 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: HOU-002719661-01 REVISION NUMBER:6 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IATA TYPE OF INSURANCE POLICY NUMBER fPdry DQ1yYYY WDGEFF U wy) LIMITS A X COMMERCIAL GLO 8376157.20 07/01/2015 07/01/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS—MADE OCCUR PREMISES Raomwence) $ 1,000,000 MED EXP(Airy one person) $ 5,000 PERSCANALSADV INJURY $ 2,000,000 GENLAGGREGATE UMITAPPLES PER GENERAL AGGREGATE $ 2,000,000 X POJCY�J� LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY BAP-8376159.20 07/01/2015 07/01/2016OVISINenfl INGLEL IMT $ 2,000,000 (Ea accidX ANY AUTO BODILY INJURY(Per person) $ ��ED SCHEDULED BODILY INJURY(Per acaderd) $ NON-OANED PEKE r $ — HIREDAUTOS AUTOSer B X UMBRELLA LIAB X OCCUR AUC 9300308.14 07/01/2015 07;0112016 EACHOCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION WC 8376109-20 07/01/2015 07/0112016 XSTATUTE ER AND EMPLOYERS LIABILITYANY PROPRIETOR/PARTNER/EXECUTIVE YIN 1,000,000 EL EACH ACCIDENT $ OFFICERMiEIvIBEREXCLUDED? � N/A (Mand3toryrn NH) E L DISEASE-EA EMPLOY $ 1,000,000 If yyes describe under DESGRiFnaN OF OPERA-nON1S below E L DISEASE-POLICY LIMIT 1$ 1,000,000 C Property MCB787839.15 07/01/2015 07/01/2016 Limit 145,131,225 ( P3/F DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,rrey be amched if more space is required) RE-7th Arntlal Healing Heart 5K,5115016,Cutdnogue,NY and AhArt tlal Harling Heart 5K R jwmk RECEIVED M@dtuck-DffkM School District included as Arldtlorel Ir>sured,except on Mriwes CaTens bon and Proporty,as ClAner of prem:es leased or graivitorsly offs&e;J fen thg 2O 1 C Arnerican Heart Association,Inc premses events,bun ally Wth respect to operations of the Amencan Hetet Associato n,Inc IUI/�K A L U ZONING BOARD OF APPEALS CERTIFICATE HOLDER CANCELLATION Mattituck-Cutchogue School District SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITHTHE POLICY PROVISIONS. AU HORZED REPRESENrrA-nVE of Marsh USA Inc ManashiMLkhedee a� oaaa �t.xer ,e*�rr OO 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 212 345-5000 1/4/2016 3: 19: 20 PM PAGE 2/003 Fax Server CERTIFICATE 4F LIABILITY INSURANCE Do 04,2016 YrN) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PROWLER CONTAGr— NAME' Marsh USA,Inc PHONE F 4400 Comerira Bank Tower �' 1717 Main Street ADDRESS* Dallas,TX 75201-7357 Alin Dallas Carts@ marsh com Fax 212-948-0519 INSURE AFFORDING COVERAGE NAIC# INSURER A.Zurich American Insurance Company 16535 INSURED INSURER B American Guarantee and Liability Insurance Company 26247 American Head Association Founders Affiliate INSURERC Axis Insurance Company 37273 125 East Bethpage Road,Suite 100 INSURERD: Plainview,NY 11803 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: HOU-002730883-01 REVISION NUMBER:4 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS t�R TYPE OF INSURANCE POUCY NLUBER AUULJS MuY YOLICY�F EXP LINrT5 A X COMMERCIALGENERALUABIUTY GLO837fi157-20 07/01/2015 07!0112016 EACH OCCURRENCE $ 2,000,000 CLAIWMADE FT]OCCUR PREMISES Eaoxurencel $ 1,000,000 MED EXP(Priv one person) $ 5,000 PERSUNALBADVINJURY $ 2,000,000 GENLAGGREGATE LIMITAPPUES PER GENERAL AGGREGATE $ 2,000,000 X POLICY❑JEcT El Loc PRODUCTS-CCMRIOPAGG $ 2,000,000 OTHER $ A AUT'owBILE LIABILITY BAP-8376159-20 07/01/2015 07/0112016 Ea acadenll $ 2,000,000 X ANYAUFO BODILY INUURY(I'&perscn) $ AAL�Ji TED SCHEDULED BODILY INJURY(Per accident) $ HIREDAUi05 NDN,C ED I (Per avadep OF $— B X LJMBRELLALIAB I X I OCCUR AUC 9300308.14 07/0172015 07/01/2016 EACHOCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMSAAADE AGGREGATE $ 10,000,000 DED I I RETENTION$ I $ A WOR(ERS;=4PEINSATION WC 8376109.20 07/01/2015 07/01/2016 X I PER STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PAMNER/EXECUI7VE YIN NIA E.L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED^ (Mandatery in NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 If Yyes describe urder DESGRIPTIONOFOPERATTONSbeIOv+ EL DISEASE-POLICYUMIT $ 1,000,000 C Property MCB787839-15 07/01/2015 07/01/2016 Limit 145,131,225 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Adddrrmal Rerrwrks Schedule,trey be attached if rrxe space is required) Re 7th Anrrd Heding Heatt 5K Dated evert' 5/15/2016 Location(dry,state) Cutdnogie,W Ofiiaal I\Iarre d Event•7th ArnLel Healing Heart 5K NrvWdk Gerrity d SUfidk is included as AddNoral Insured,except on INorke?s Corrpersatim and Roperty,as a%rner of prerrises leased or g-Aitoudy offered forthe Arnaricaa Pgari E� Association,Inc off prerrises everts,Ixrt oriy Wth respect to opemicns d the Arrencan Heart Association,Tru Rt MAR 1 2016 CERTIFICATE HOLDER CANCELLATIO14 County of Suffolk SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P 0 Box 144 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN West Sayville,NY 11796 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc Manashl Mikhellee �`�rAa ear►; ,t x � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD American American Heart I Stroke Association Association life is why- . .. .... . .. ... .. . .. . . .. . ... . . . . . . . . .. . .. . .. ... .... .. .. .... . . 125 East Bethpage Rd. Suite 100 1 Plainview, NY 11803 www.heart.org Town of Southold Attn: Vicki Toth Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 January 26, 2016 Dear Town of Southold: The American Heart Association would like to hold its annual Healing Heart 5k on May 15, 2016 at Pugliese Vineyard. This 5k run/walk is held to raise much needed funds for research and education of heart diseases and stroke. The 5k route will bring runners throughout the property of Pugliese Vineyards. After the run, there will be an award ceremony and music provided by a local band, The Rum Hill Rockers, until around 2 p.m. on the showmobile. An official request has been submitted to North Fork Sanitation asking them to provide an 8 yard dumpster for trash removal for the event site and Island Portables will provide 10 restrooms in addition to the bathroom on site. The parking lot on the premises of Pugliese Vineyards is 190,270 square feet providing space for 634 cars. This should suffice for up to 1,000 runners. If we do have more than 1,000 runners, we do have a back-up parking plan. The American Heart Association has submitted an official request to the Mattituck-Cutchogue School District for use of the Cutchogue East Elementary School parking lot for overflow parking. ; Please note, this request has been approved by the elementary school. In the case that we do needrthe_overflow,parkipgswe,will.work with the police department to provide ` crossing guards, an extra crossing sign and volunteers to ask guests to use,.the• crosswalk. John Scalamandre will be leading the traffic control and parking. He has run- the parking for the past six years. _ The check request has been submitted and will be sent uncle separate cover. Please ,' feel free to contact me with any questions or concerns_ at 516:.962,-0799.'- P 31J" 9 Best Regards, RECEIVED Nora Donnelly MAR 1 Event Coordinator American Heart Association _ ;zoivl�G BOARD°vF APPEALS,, "Building healthier lives, ; free of cardiovascular life irs why ^ es por la vida�'' �'1A diseases and stroke." phase rerncniher rrc Amenam Hcan Assxradan in your wfil, American American RECEIVED HeartI Stroke Association Association life is why- F E B 2 2 2016 Founders Affiliate Southold Town Clerk 125 East Bethpage Road, Suite 100 i Plainview, NY 11803 www.heart.org Town of Southold Attn: Board of Directors Town Clerk's Office, 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 February 16, 2016 Dear Board of Directors: The American Heart Association has submitted the permit to hold its annual Healing Heart 5k on May 15, 2016 at Pugliese Vineyard. I am requesting that the board waive the permit fee as this 5K raises critical funds that go towards funding educational programs and research about cardiovascular diseases and stroke. Right now, heart disease is the number 1 killer of Americans. Stroke ranks fourth and is a leading cause of severe adult disability. Each year,these diseases kill more than 811,000 Americans and one of every three adults is affected by some form of cardiovascular disease. The mission of the American Heart Association is to build healthier lives free of cardiovascular disease and stroke. We are working towards improving the cardiovascular health of all Americans by 20 percent, and reducing deaths from cardiovascular diseases and stroke by 20 percent, by the year 2020. This 5K brings people of all ages out to get active and healthy by running or walking. We're dedicated : to creating a culture of health in our community so that people can live life to its fullest: Life is why we do what we do. If you have any questions or concerns regarding the event or the work of the'Americarrr: Heart Association please feel free to contact me at 516-962-0799. Best Regards, Nora Donnelly PECEIVF15 4 Event Coordinator , American Heart Association = A 2016:: Z®NINGGBOARD OF APPEALS 'Building healthier lives, r. tree of cardiovascular life is Why- es por la vid, t nTM, diseases and stroke." Ple=ase remember the American Heart Association in your wdh' _ _ `„ American American HeartI Stroke Association Association e life is why 125 East Bethpage Rd Suite 100 1 Plainview, NY 11803 www.heart.org Town of Southold Attn: Board of Directors RECEIVED Town Clerk's Office, 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 �� 2Q January 26, 2016 Southold Town Clerk Dear Board of Directors: The American Heart Association has submitted the permit to hold its annual Healing Heart 5k on May 15, 2016 at Pugliese Vineyard. I am requesting that the board waive the permit fee as this 5K raises critical funds that go towards funding educational programs and research about cardiovascular diseases and stroke. Right now, heart disease is the number 1 killer of Americans. Stroke ranks fourth and is a leading cause of severe adult disability. Each year, these diseases kill more than 811,000 Americans and one of every three adults is affected by some form of cardiovascular disease. The mission of the American Heart Association is to build healthier lives free of cardiovascular disease and stroke. We are working towards improving the cardiovascular health of all Americans by 20 percent, and reducing deaths from cardiovascular diseases and stroke by 20 percent, by the year 2020. This 5K , brings people of all ages out to get active and healthy by running or walking We're dedicated to-creating`.a,culture;of health in our community so that people • ._:',_; _'.' .' can live life to its fullest. Life is why we do what we do. If you have any questions or concerns regarding the-event or the workof the American Heart Association please feel free to contact LLme-at.516.-962-=0799. Best Regards, Nora Donnelly -d``:3 /d? Event Coordinator RECEIVED American Heart Association i. MAR d, '2016 a:; ..`° oI�INGG _ .,BOARD'OF°.-ARREAt.� ' - `Building healthier lives, free of cardiovascular life is why ' es por la vid`aTM p'""° diseases and stroke." 6 tea ere nen:b4r the d rrrrcafr r tc,zrt A soair f,'<ar,n ycrsy#U. -ArOerican ,. Heart Assoolationm^ ' !-corn(Intl Live Arnerican Heart Association --Venue Agreement This Agreement is between the American Heart Association,.Inc. ("AHA"), a New,York not-for-profit corporation, having its office at 125 East Bethpage Rd.,Suite 106, Plainview, NY 11803 and Name:The name of the owners of the property: Palmer Vineyards, LLC , (hereinafter referred to as IlOwner") Venue Property and Location: The name and mailing address of the location of the venue property.is: Palmer Vineyards Property located at: 34995 Route 25,.Cutchonue, NY AHA Event Name and Purpose Healing Heart 5k Run/Walk—To raise funds for research and education of heart diseases and stroke: Date(s) and Time(s) of Event: The date(s) of the Event are May 15, 2016 and the times) of the Performance shall be 10:00 a.m, to 2:30 pm.The AHA will be using the venue property from setup on 5-14-16 and 6:00 a.m.—4:00 p,m. on 5-15-16 \\\\\\\Y\\YYYk\\YtY\YY\\YtYY\Y■\■\YY■Y\\Yt\\\\\t■■Y■\\t\YYY\t\YYYYYYYYt\tY\\\■t\\\i\t\Y.\t\tY\\Y\■YYM\\\\\Y\\Y.YY..Y.\Y\Y In consideration of the mutual promises of the parties and other good and valuable consideration,the receipt and sufficiency of which are hereby acknowledged by both,the AHA and Owner agree to the following terms and conditions: Owner agrees to allow the AHA to enter and utilize the Venue Property for the Event Purpose on the Date and for the Time described above at no charge to AHA. This right shall terminate at the end Time on the Date. Owner agrees to release, indemnify and hold harmless the American Heart Association, Inc., its officers, directgrs, employees,volunteers, agents,subcontractors and guests from any and all liability, claims, demands,and causes of action whatsoever, resulting from the negligence and willful'misconduct of Owner in ccnnectlon with the venue property. The foregoing release and Indemnification agreement shall be as broad and inclusive as Is permitted by the State in which the Event is conducted.This provision shall survive termination of this Agreement. 'The Owner who is executing'this Agreement hereby warrants and represents that he or she has the full power and authority to execute this Agreement on behalf of Owner.Vendor shall comply with all applicable federal, state and local laws and regulations(including but not limited to 41 C.F.R. Sec. 60- 1.4(a),60-250.5,60-300.5(a),60-741.5(a), and 29 C.F.R, Sec.471,Appendix A to Subpart A)as applicable.This Agreement embodies the entire agreement and the understanding of the parties with _ respect to the subject matter of this Agreement. American Heart Association,Inc. _ .Falmer Vineyards LLC (Owner) Print)ame; KathyMunsch Print Name: Title; Re 6onal Vice President Title: Date; 1— L _ Date: 1 RECEIVED MAR 1 2016 ZONING BOARD OF APPEALS L 1 DATE(M MIDD/YYYY) CERTIFi%,ATE OF LIABILITY INSURAf:...E 03/21/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh USA,Inc. NAME: PHONE FAX 4400 Comerica Bank Tower A/C No Ext A/C No): 1717 Main Street E-MAIL Dallas,TX 75201-7357 -ADDRESS, Attn.Dallas.Certs@marsh.com Fax.212-948-0519 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Zurich American Insurance Company, 16535 INSURED INSURER B:American Guarantee and Liability Insurance Company 26247 American Heart Association Founders Affiliate INSURER c:Axis Insurance Company 37273 125 East Bethpage Road,Suite 100 INSURER D: Plainview,NY 11803 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: HOU-002742641-01 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO 8376157-20 07/01/2015 07/01/2016 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE M OCCUR PREM SES Ea occurrence) cccu RENTED $ nce 1,000,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE_ $ 2,000,000 POLICY� PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X JECT OTHER $ A AUTOMOBILE LIABILITY BAP-8376159-20 07/0112015 07/01/2016 (CEO,MBINED ccident SINGLE LIMIT $ 2,000,000 a X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccidenl B X UMBRELLA LIAB X OCCUR AUC 9300308-14 07/01/2015 07/01/2016 EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ $ A WORKERS COMPENSATION WC 8376109-20 07/01/2015 07/01/2016X STATUTE ORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YN/A E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ C Property MCB787839-15 01/0112015 07/0112016 Limit: 145,131,225 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re.7th Annual Healing Heart 5K;5/1512016,Cutchogue,NY Palmer Vineyards islare included as Additional Insured,except on Worker's Compensation and Property,as Owner of premises leased or gratuitously offered for the American )= Heart Association,Inc off premises events,but only with respect to operations of the American Heart Association,Inc. MAR I ZONINGCERTIFICATE HOLDER CANCELLATION N Palmer Vineyards,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Palmer Vineyards,LLC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AUn Kathy LeMorzellec ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 2125 Aquebogue,NY 11931 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhepee ctu�►� �,4�u-t��w < ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 0102( LOC#: Dallas AC"o ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA,Inc. American Heart Association Founders Affiliate POLICY NUMBER 125 East Bethpage Road,Suite 100 Plainview,NY 11803 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance The property policy evidenced above-MCB787839-15 with Axis Insurance Company contains various sublimits and is subject to deductibles specific to various perils covered If you would like additional information regarding these sublimits or deductibles,please contact Karla Lott(214)303-8207(karla.lott@marsh.com),at Marsh USA Inc. Other property deductibles may apply per policy terms and conditions. P C? RECEIVED LIAR A' 2016 ZONING BOARD OF APPEALS ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r s d — . . M m w.+.a.e.. ALI r _ 1 Yuv�i Su1Mn �I �( A R , Y gNM , y finhh , x Start • �� Pugliese�Vi ?.yt Goo* Th rl I 9q4 imagery Date- 3/6/2012 41'01'40-82" N 72'28'39.16' w elev10 eye alt 1.53 km .—- ,--s 5 N D A 485 ,Wf q.. NOv089 EE SEC O � -- _ .. OB-'197 _ - 09-02-98 N3180M"' MATCH MATCH L� 12-0699 —�—LINE MATCH LINE�_— MATCH 11-29-00 12 12 eR/� FOR PCL 1 02-2601 w tr 12 7 �, G 7 Z 2 9A SEE SEC t 05-16-01 14 BA 085.02-010 05.18-01 (TOWNOF SOUTHOLD (0/ 09-21-01 DEVELOPMENTRIGHTS) 16-030, 166- 1) 06-1603 V`'\' 13 ! 09-0303 (TOWNOF SOUTNGLD 1x0303 r� I �� EVELOPMENTRIGH75) y,SgB 04.22-04 0 111 07-21-04 z I 'Q v �, 06.16-04 ,I m 1o06-06- v 10-26-04 w I �Z<1� ' k -1 604 vl \ 1 16 3 'd 01-27-08 I 12 B OS 1 BA \\ 4 04-0308 0605-07 7pWN 16-1607 OF I A)p `�. 4y ✓ -) 0624-09 2 L,,l \. O i SOUOLD 09.17-09 I \ 162 62�-a\ 0606-10 f \P� 10.22-10 I 14 a ' �� 131 4 � 2d 112 2 53 A n1 [� 9A 5� o 7 1210 1 OA(c) -,"';OL, Sve OE.LOPMENTMGNTS) d�1A I � 7 $ W I ee �6 8 I 114 y�' 35A(c) '. 221 z nI $ m a as 215A(c) 1UNION FREE SCHOOL DIST NO 8 nP a w I V0V411, 115 91 u) x —5 '� 4 4, 10 6 5A 10P 1 16A O 4 V,6 1, a a 117 �(�g(�`f��J�/ 1 e4r- RT S � 11 z1s � e \\ �'• I a 24 4A c __ 121 g i'23 'SB 2Bq � C�IV�p W 6-v J 132 19A 3 41 7 s' sq(D/ 1.-9A a 4134 6A v° gpP � q(q sl 21 3 74 a 30A QSA 16 U 2 s' Ib X16 8 ? 1 (c) f Oq�c) 163 162 n 7>^ 3 u 18" g w I 'ti •Y 9 i+z EUGENES y rer n 19 20 w I '9 3 ,q, r� 23A 31A(c) O 4es 3 I IA(c) G 1 1 e m 1112 l) 4 1 �i "9e d s 6 4 O a OQ+,a 6-o Easr \ 9 Y / B e 4i s CREEK 9 9 ' a 70 W 377 o FOR PCL NO a 1A eP, ''9 r •'o�o '� - z ` SEE SEC NO ° Oj 9r FOR PCL NO 103-01-019 3 �' l '�' SEE SEC NO W N 314 2R2 b L �9� 103-02-001 `� _ w MATCH —Z LINE $ Ma1cH—� UNE U) x F `9 E ab L P—M.—L.. SUELnrswn Ld No. "• Bldi Lurvl —���— Sdad Ddrd LNa --SLl1-- Itt4rad OlsWd Lim —=M-- UNLESS ORAVr1J OIE—E—P—ES E Dmmes eomnn,o..m. —�-- S�E4i•.sm abWBNS No (21) bl6-w O Fve Oend,am --F-- Pduse Dyhf lax --q-- SCRDa"' 59OWNO fJSTweR sEN£R_ E VO4+O�db Una H:dmolOm—--HST-- RAE 2829 NYORPNI UGM 4445 L"4TER N suaam,sm� �"-•- soeam�.� m LSNadR,L,A --L-- nawPa�namd„na--A-- _ _ K 90 usE D awl N. 23 Daea/�o 121A(tl)ar 121A e..n LNe --- Pah Dsnd We --P-- atewaivr Drsuw Una--vfN-- WIAN£ wLSTEW CaIdGMNm 121 A(e) N6pe Lme ----- Se..cr DdM LM -- 62/13.2016 23:21 151545 "'0 AMERICAN HEART aGSOC PAGE 61103 American AMerican Heart ` Stroke American Reawt Assacikio� Assacid4idr� �196e�ci�$ial 125 Mast Bethpage Road,quite 100 Plainview,NY 11,503 Phone: Fax: 944-150 Phone. 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Ud:i'r4 '+.:k� � �~'�''.ti:rw�ti.%.'�'._' r ,. ;.v_,ta• i'...:.h'.'�+fdi:"�,:,'Hhi'S•y�Bi''t,�(• a tY:7�°it ,'a•t'al'n, " Toth; Vicki From: Lanza, Heather Sent: Thursday, March 03, 2016 8:19'AM To: Toth,Vicki Subject: RE:special event No issues From:To Vicki Sent:Wednesday, March 02, 201612:16 PM To: Glew, Claire<Claire.Glew@town.southold.nv.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.nv.us>; Flatlet', Martin<mflatlev@town.southold.nv.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Fisher, Robert<Robert.Fisher@town.southo Id.ny.us> Subject:special event - Dear All= Please review the application for a 5k run at Pugliese vineyard. It is under'computer', southold shared S,everyone, special event applicaitioris, 2016 healing heart 5k 2016. Please comments/concerns to me. Thank you, Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) Toth, Vicki From: Flatley, Martin Sent: Wednesday, March 02, 2016 3:41 PM To: Toth,Vicki Subject: RE:special event I haveho objections to this event being held as in the past.We will-work with them on their overflow parking•plans again. Martin Flatley,Chief of Police Southold,Town Police Department 41405 State Route 25 Peconic, New York 11958 631-765-3115 From:Toth;Vicki 'Sent:Wednesday;March 02, 201612:16 PM To: Glew, Claire<Claire.Glew@town.southold.nv.us>; Lanza, Heather<heather.lanza@town.southold.ny.us>; Webster, Kevin<kevin.webster@town.southold.nv.us>; Flatley, Martin<mflatley@town.southold.ny.us>;Spiro, Melissa <Melissa.Spiro@town.southold.nv.us>; Fisher, Robert<Robert.Fisher@town.southold.nv.us> Subject: special event Dear All,= Please review the application for a 5k run at Pugliese vineyard. It is under'computer, Southold shared S,,everyone, special event applicaitions, 2016 healing heart Sk 2016. Please comment's/concerns to me. Thank you, Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) If T °C Toth, Vicki From: Glew, Claire Sent: Monday, March 07, 2016 11:29 AM To: Toth, Vicki Subject: RE:special event Vicki, The Assessors have no objection to this event. Claire From:Toth,Vicki Sent:Wednesday, March 02, 2016 12:16 PM To: Glew, Claire<Claire.Glew@town.southold.ny.us>; Lanza, Heather<heather.lanza@town.southoId.ny.us>; Webster, Kevin <kevin.webster@town.southold.nv.us>; Flatley, Martin<mflatley@town.southold.ny.us>; Spiro, Melissa <Mel issa.Spiro@town.south old.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.ny.us> Subject: special event Dear All = Please review the application for a 5k run at Pugliese vineyard. It is under`computer', Southold shared S, everyone, special event applicaitions, 2016 healing heart 5k 2016. Please comments/concerns to me. Thank you, Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809 631-765-9064 (fax) 1 Toth, Vicki. From: Fisher, Robert Sent: Tuesday, March 22, 2016 3:23 PM To: Toth,Vicki Subject: 'RE:special event Vicki I have no concerns about the date or the location of the event. Bob Robert Fisher Fire Marshall, Town of Southold robert.f isher@town.southold.ny.us (W) 631-765-1802 - (C) 631-786-9180 PRIVILEGED AND CONFIDENTIAL COMMUNICATION, CONFIDENTTALITYNOTICE This electronic mail transmission is intended only for the use of the individual or entity to which it is addressed and may contain confidential information belonging to the sender which is protected by privilege. If you are not the intended recipient,you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited.,If you have received this transmission in error,please notify the sender immediately by e-mail and delete the original message. From:Toth,Vicki Sent:Wednesday, March 02, 201612:16 PM To: Glew,Claire<Claire.Glew@town.southold.nv.us>; Lanza, Heather<heather.lanza@tow n.southold.ny.us>;Webster, Kevin<kevin.webster@town.southold.ny.us>; Flatlet'; Martin <mflatlev@town.southold.nv.us>;Spiro, Melissa <Melissa.Spiro@town.southold.ny.us>; Fisher, Robert<Robert.Fisher@town.southold.nv.us> Subject: special event Dear All = Please review the application for a 5k run at Pugliese vineyard. It is under'computer, southold shared S,everyone, special event applicaitions, 2016 healing heart 5k 2016. Please comments/concerns to me. Thank you, Vicki Toth Zoning Board of Appeals Town of Southold 631-765-1809• 631-765-9064(fax) Owner: American Heart Assn 5K @ Pug File #: WP318 Address: 34515 Main Road Code: 06L Agent Info Nora Donnelly c/o American Heart Association 125 East Bethpage Road, Suite 100 Plainview, NY 11803 Phone: 516 962-0799 Fax: Email: i i ZBA TO TOWN CLERK TRANSMITTAL SHEET (Filing of Application and Check for Processing) i i f ' DATE: 4/8/16 ZBA# NAME CHECK# AMOUNT TC DATE STAMP r RECEIVED American Heart Association Healing 00752275 $250.00 WP318 Heart 5K @Pugliese APR 1 1 2016 Vineyards Southold Town Clerk 'i • �l b� "I DETACH AT PERFORATION;BEFORE DEPOSITING CHECK w:r,, ;<•2THI3•CHECK *AKN 6f[ltNFPHGEM"WrrWAT1ERMMRW - - - --- - ; •tllL, A"F.'ANQLE,TtO ,v;: r"«._,,, X,.*,_p,l,;e,,J rp,rx,. ,.f. ry'.•r;* .�,,,�..�z -.,�Ktirs� � yel+�i s:'p„ ,:�•i tires,'---'. - �•, _,yy•1 r." 1 '� J { '"`a.v .2,,.yrr L ♦ ,uz .�r.«M1t..;r !f)L�.Y tli^-..:_ j /.p M 'r.'^;f,,,v a 4,yL� ,�`<iEd: > t, r„ J ,`,• .3:,. { �•�y^�S!er �C4any}IQ�r1"7��A SOC�Bti<011' .r ,Ss .;,-J•• „� h-.�''�i•Y>�t•.tt"'p�'�,S}.�1�;<:,q•�;.?µBanli f' `r(4' r .i. .:a`:,ii j '�''}N_�.`�. 88.130=178c,`J'�":4 - ;,t•,; }t�•aS.t,=:1'�i Krr ';n!4,`i4,� �� ^`y''•` .s�,.K Gia t� f aj •r'. i,, 0 Ami N.�. 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M/y;.�5�s'���; >ti4vi'•"t>,;�.-�.,,c. - . , �\;% •`\:� aI� a .., w���„ ,Sou lio;�d�.N�t�1 '1=1 :�-r i�';�,f��� :a,,>•,-<_ f , _ - - : '-`� , '`���''�2•e,.a ��'rty4 Yj���+.-,c�M;J�'�1;>..t •It-�.���'�»,?����;x':�i:�'{1,T�,�,bp�ne�.•;I,. <+�°��ffa;rt.�`:i,j j;ahs=�io;7,� ,F;b;`' �• .*�• .�L:.,";�" - �i •�a+.<Lo+:',,,,.r'���:,,rtdt,t,.ngx..av,. •,lr;1.s.��J��x`d�.h.;•v.r.tia+.r.."p1,1, ;�=i,u: ��',d�a k�;,f•�'t,.u.�,rk�A, - _ :;\1r - �� c "i. * * * RECEIPT * * * Date: 04/11/16 Receipt#: 202698 Quantity Transactions Reference Subtotal 1 Public Events WP318 $250.00 Total Paid: $250.00 Notes: Payment Type Amount Paid By CK#00752275 $250.00 American, Heart Association Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: American, Heart Association 7272 Greenville Avenue Dallas,TX 75231-4596 Clerk ID: SABRINA Internal ID:WP318 i R� North Fork Gue i aAp r loe -, 4W Pugfieesee eyards t Police f Crossing Guards '�► a Parking at Elem CutchogueElementaryj Toth, Vicki From: Kangas, Melissa <Melissa.Kangas@suffolkcountyny.gov> Sent: Tuesday,April 12, 2016 4:48 PM To: Toth,Vicki Cc: Fischer, Lauretta;Amakawa, Andrew Subject: RE: Special event at Pugliese Attachments: healing heart 5k 2016.pdf Dear Vicki, In regard to the special event at Pugliese Vineyards, please be advised that the type of activity described, i.e. runners going over SC PDR land,would not be permitted. Can you please confirm this activity will not occur on SC PDR land. Thank you, Melissa Xangas Planning Aide Suffolk County Dept. of Economic Development and Planning 100 Veterans Memorial Highway,2nd Floor Hauppauge, NY 11788 631-853-4910 Tel 631-853-4044 Fax 3 "CAM". practiceGREEN Save a tree Read,don't print,emails CONFI DENTIALI TY NOTI CE: This electronic marl transmission is intended solely for the use of the individuayentity to whom it is addressed and may contain confidential information belonging to the sender. If you are not the intended recipient,you are hereby notified that any disclosure,copying, distnbuhon,or the taking of any action in reliance on the contents of this information is strictly prohibited If you have received this transmission in error,please notify the sender immediately by e-mail and delete the original message. From: Toth, Vicki [mailto:vicki.toth(�btown.southold.ny.usl Sent: Wednesday, March 02, 2016 10:44 AM To: Amakawa, Andrew; Fischer, Lauretta; Peconic Land Trust(nfsc peconiclandtrust.orcl) Subject: Special event at Pugliese Please review the attached application for Healing Heart 5k to be held at Pugliese Vineyards. Kind send comments/concerns to me. Thank you, i BOARD MEMBERSSouthold Town Hall Leslie Kanes Weisman,Chairperson �'A®f S®ury® 53095 Main Road• P.O.Box 1179 Southold,NY 11971-0959 Eric Dantes Office Location: Gerard P.Goehringer G Q Town Annex/First Floor,Capital One Bank George Horning �o ® YO 54375 Main Road(at Youngs Avenue) Kenneth Schneider COU (,ta Southold,NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel.(631) 765-1809• Fax(631)765-9064 APR 2 9 2016 American Heart Association 125 East Bethpage Road, Suite 100 Plainview,NY 11803 Attn: Nora Donnelly �f Re: Event Permit 4WP318—Healing Heart 5K ' Dear Ms. Donnelly: Attached please find for your information, an e-mail from Suffolk County regarding activities which are not allowed on Suffolk County Development Rights Preserved Land. In the future when planning your event at Pugliese Vineyard or any other winery,please keep this information in mind. Si a el , Leslie Kanes Weisman Chairperson Attachment Toth, Vicki From: Kangas, Melissa <Melissa.Kangas@suffolkcountyny.gov> Sent: Tuesday, April 12, 2016 4:48 PM To: Toth, Vicki Cc: Fischer, Lauretta; Amakawa, Andrew Subject: RE: Special event at Pugliese Attachments: healing heart 5k 2016.pdf Dear Vicki, In regard to the special event at Pugliese Vineyards, please be advised that the type of activity described, i.e. runners going over SC PDR land, would not be permitted. Can you please confirm this activity will not occur on SC PDR land. Thank you, .7►r1eCiissa Xangas Planning Aide Suffolk County Dept. of Economic Development and Planning 100 Veterans Memorial Highway, 2nd Floor Hauppauge,NY 11788 631-853-4910 Tel 631-853-4044 Fax t - `1fi r pracficeGREEN Gave a Tree Read,don't print,entails CONFIDENTIALI TY NOTI CE: This electronic marl transmission is intended solely for the use of the individuallentity to whom it is addressed and may contain confidential information belonging to the sender If you are not the intended recipient,you are hereby notified that any disclosure,copying, distribution,or the taking of any action in reliance on the contents of this information is strictly prohibited If you have received this transmission in error,please notify the sender immediately by e-mail and delete the original message. From: Toth, Vicki [mailto:vicki.toth@town.southold.ny.us] Sent: Wednesday, March 02, 2016 10:44 AM To: Amakawa, Andrew; Fischer, Lauretta; Peconic Land Trust(nfsc@peconiclandtrust.org) Subject: Special event at Pugliese Please review the attached application for Healing Heart 5k to be held at Pugliese Vineyards. Kind send comments/concerns to me. Thank you,